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David E. Marcinko [Editor-in-Chief]

As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

Later, Dr. Marcinko was a vital and recruited BOD member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.

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As readers and colleagues know, I’m a great fan of the Finnish culture, lifestyle and people. I’ve visited the country several times, touring and speaking, meeting with government, academia and local industry leaders and politicians in Helsinki, Tempere, Seinajori, Turku, Oulu and Northern Lapland, among other places; and especially Rovaniemi which is home to the world’s most northern branch restaurant of McDonald’s. Of course, the famed Arktikum there is also very comprehensive museum of arts, science and technology. Every time my wife and I visit, we learn more about the language, the arts and tradition.

Recent Visit to Finland

On our most recent month-long visit to Finland, we were able to visit a Japanese Honbu [karate gymnasium], meet several black-belt Taido karate students, and even take an actual class to stay in shape. I’ve been an avid runner for more than 30 years so aerobic cardio-vascular output was not-problematic. The trip was also remarkable for the many insights into the challenges of the Finnish healthcare system, their plans for eHRs and their emerging interest in American medical care. I’ve also made several friends and new colleagues, ingested cold raw dead-fish stew, and mastered the Finnish railway system. And so, my national healthcare service impressions follow; along with a bit more about the art and science of Taido styled karate.

Taido in Finland

Prior to our departure, we asked my daughter’s karate instructor, Sensei Uchida in Atlanta, GA, about the possibility of attending a Taido work-out in Finland. We were surprised when he informed us that the country has the largest number of Taido students in the world, second only to Japan. This interesting fact was later confirmed by the Finnish Athletic Association. The reason is that this form of exercise is covered under the country’s national health insurance system and is available to all citizens, free of charge. But, of course, income taxes are very high.

In fact, we learned that just the city of Helsinki itself, had nine Honbu’s to choose from and we selected what proved to be the most interesting, indeed! Another American instructor, Sensei Brent, mentioned that he visited the country a few years ago and still has some Taido friends from there, too.

The Taido Karate Honbu

Built during World War II to protect the population living in the City of Tempere from bombs, the Gymnasium in North East Helsinki is built into the side of a huge granite mountain, not unlike our own Stone Mountain here in Atlanta. Since it was originally constructed as an air-raid shelter during WW II, with many snaking corridors and smaller caverns, it is cool all year round with many miles of tunnels maintaining an even 56 degree temperature, just like natural underground caves. No air conditioning is needed for the short summers, and no heating system is needed for the very long winters.

Enter the Health Gymnasium

As we entered the “Health Gymnasium” as it was known, it was as if we were walking into a long tunnel through the woods, about 100 yards long. This entrance to the bomb shelter was really a railroad track line that was still visible after all these years. It was guarded by two huge iron doors several stories high. Inside, was a general reception area where we were directed to the actual Taido Honbu, itself, known as Budo # 6. As we walked through the long winding corridors, we noted that the walls were solid granite, painted white, and that each studio was separated only by a color-coded curtain; much like long rows with individual partitions. There was no graffiti and, although there was no sound-proof protection, the entire Gymnasium was surprisingly quiet.

A Linguistics Error

As we walked along, we noted studios for fencing, gymnastics, boxing and kickboxing, table tennis, ballet, weight lifting, volleyball, rowing and many different types of Karate and other martial arts, like Aikido, Bando Thaing, Capoei, Gatka, Hapkido, JuJitsu, Judo, Kendo, Kung Fu, Sumo and of course Tai Kwon Do. But alas, no Taido Honbu! We were horrified. Did we make a linguistic error! Was the term Taido misinterpreted as a generic terms for all these others types of martial arts or Karate forms? My daughter Mackenzie’s enthusiasm was crushed [after seven years of intensive study, with both national and international competition] as she is a black-belt candidate still in need of some teaching and karate internship credits to reach her ultimate goal. After-all, she brought her Gi [uniform] a long way to not to be able to use it. So, back to the reception area we went, inquiring again in our rudimentary Finnish. Fortunately, the problem was not a language faux-pau at all, but a one of timing. In our excitement, we had merely arrived an hour too early. Soon, the sign on one of the larger partitioned studios was changed to “TAIDO”, and students began filling-in, talking, laughing and giggling before class, just like they do in Atlanta.

Teaching Introductions

The class was comprised of blue, green and brown belt student [there are eight belt ranks], even though we took care to register for the same rank as daughter, Mackenzie. But, it was for about a dozen young adults, ages 18-30, and evenly split between guys and gals! No children. One student had been taking classes for about two years (she averaged 3-4 classes per week), while another was in his ninth year (able to participate only about once or twice per week). Nevertheless, Mac was agreeable to work-out with the adults, under the leadership of Sense Arie, who spoke English and was very cordial to us. When he then asked us what we had learned, we quickly listed Untai, Sentai and Hentai hokis [ritual movements; a Hoki is a pattern of techniques originally put together for mental and physical health and as a practice form of “free fighting.”], as he replied, “that will be sufficient for today”. No doubt, he and the other students were as curious about us, as we were about them. Introductions were made to all students, including moms, dads, grand-moms and grand-dads. We then settled down to watch Mackenzie and the class.

Class Comparisons

Like the Finnish healthcare system, the Taido karate class itself had several similarities and several differences compared to what we are used to, in Atlanta, GA.

1. First, the students and instructors wore the same colored GIs; solid black pants with roughly woven white tops. The GIs also were fancier with many epilates, patches and insignias. The belt color-coded system of the States was not used. Shoes were left outside, all bowed as a sign of respect upon entry, and lined up according to rank. There were no mirrors, horizontal warm-up bares, and virtually no padding in the mats on the floor! The epithet OUS, was replaced by a loudly shouted, EEEE!

2. Second, it was a longer class; an hour and a half, with a ten minute break in-between. Warm-ups were also longer and a bit more strenuous and aerobic orientated; running backwards, sideways and with lunges often performed in-between the hoki’s. But again, this was an adult class.

3. Third, the class was subdivided into smaller groups like our own, to practice kicks and punches initiated by sound or hand movement, as reaction-time was tested and improved. Mac’s partner had to kneel for her to reach his out-stretched hands, and she in turn had to raise her hands high overhead, as palms were used as targets. Her older partner worked with great diligence to best his younger opponent.

Finally, the ritualized hoki’s terminated a bit differently than our own, and they were performed much more slowly; almost ritualistically and with great concentration. And, form was a bit more casual than what were are used to, and not as sharp or precise as American Sensei Uchida or Sensei Matsuaki usually demands.

Health Status of Finlanders

Health services are available to all in Finland, regardless of their financial situation. Public health services are mainly financed from tax revenues. The child mortality rate in Finland is one of the lowest in the world; the infant mortality rate is below 4% and the life expectancy for a girl born now is 81 years, for a boy it is 73 years. Much like the US, the life expectancy of Finnish men has deteriorated by cardiovascular disease, excessive consumption of alcohol and accidents. Cardiovascular mortality has declined in response to effective health and nutritional education in recent decades but excessive blood cholesterol levels and obesity remain common in Finland. Smoking and drug abuse are significantly less frequent in Finland than in Europe on average. But, alcoholism and depression are national concerns because of the dark, prolonged and harsh winter climates. The aim of Finnish health policy is to lengthen the active and healthy lifetimes of citizens, to improve quality of life, and to diminish differences in health between population groups. Prevention receives particular emphasis in primary health care.

Finnish Healthcare System

The larger health care system in Finland is attracting international attention. For example, the European Observatory on Health Care Systems just launched a report examining Finland’s health system alongside that of other European countries. The system also has certain special features compared with systems in other countries. The main responsibility for organizing and financing health care is delegated to 448 local municipalities, which have exceptionally small and homogenous population bases, by US comparison. Another special feature is the existence of parallel financing and delivery systems alongside the municipal service system. The Finnish health care system survived the severe economic crisis of the 1990s fairly well, even though marked cuts were made in many public-sector budgets. As a result, it has emerged stronger today. The quantity and quality of health care services were largely maintained by improved management, efficiencies, electronic connectivity and resource allocation. A number of other initiatives are now developing in different directions.

Finnish Medical Association

On a more grass-roots level patient-care basis, the Finnish Medical Association [FMA] collaborates with various authorities and decision-making bodies in relation to the development of personalized medical care in Finland. It pursues patient initiatives and issues a number of statements each year with the aim of improving health care and related legislation, and puts forward plans to ensure a sound financial basis for provision of health services. For example, the national strike by physicians in 2001 drew national attention to the critical lack of resources provided for health care. The FMA plays a significant role in establishing a general patient insurance scheme and developing a family-doctor [US medical-home concept] system for Finnish health centers and practitioners. The Association promotes the rights of patients to have access to the treatment they need promptly. But, the possibilities for choosing a doctor and place of treatment need to be improved.

Contemporary Profile of a Health System in Transition

The Finnish healthcare system, much like the domestic healthcare system, is undergoing a period of reflection, modernization and reform. A special report, known as the Health Care Systems in Transition (HiT) series, profiles and analyzes the health care systems of over 40 European countries, Australia, Canada and the USA. The report for Finland was written by Ms Jutta Järvelin, Researcher at STAKES (the National Research and Development Centre for Welfare and Health), and in collaboration with the Finnish Ministry of Social Affairs and Health and the Observatory. STAKES is a center of expertise overseen by the Ministry of Social Affairs and Health.

On Finnish Longevity

Finnish super-centenarian Aarne Armas “Arska” Arvonen, the oldest Finnish male ever, just passed away at age 111 on January 1, 2009. He was the last living person in Finland who was born in the 1890s, and the third oldest man in Europe. He was also the seventh oldest man in the world. At the time of his death, Aronen was considered among the 20 oldest verified men to have ever lived in Europe.

Assessment

The formal report, Health Care Systems in Transition – Finland [Vol. 4, No 1. 2002]; Copenhagen, European Observatory on Health Care Systems, 2002 is available on the European Observatory on Health Care Systems website:

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Nearby, the Danish government’s now infamous “fat tax” has caused an international uproar, applauded by public health advocates on the one hand and dismissed on the other as nanny-state social engineering gone berserk.

I’ve heard a lot of shocking things since arriving in England five months ago on my sabbatical. But nothing has had me more gobsmacked than when, earlier this month, I was chatting with James Morrow, a Cambridge-area general practitioner. We were talking about physicians’ salaries in the UK and he casually mentioned that he was the primary breadwinner in his family.

Finland’s government announced a long-term plan to start scaling back its welfare system, one of the most generous in the world, aiming to preserve its triple-A credit rating in the face of a slower economy and aging population.

In 2013, U.S. was ranked number 46 (out of 51 countries) in Health Care

According to Bloomberg’s second annual ranking of countries, the United States is ranked near the bottom when comparing health care efficiency to other countries like Singapore (ranked #1)

• U.S. Rank in 2014 is 44 out of 51 countries.
• U.S. Efficiency score is 34.3. Number one was 78.6.
• U.S. Life expectancy is 78.7. Number one was 83.5.
• U.S. Health-care cost as percentage of GDP is 17.2.
• U.S. Health-care cost per capita (US$) is 8,895.
• U.S. Change in health-care cost per capita (US$) is 428.07
• U.S. Change in GDP per capita (%) is 3.8. Number one was 134.0.
• U.S. Change in health-care cost per capita (%) is 5.1. [Number one was 174.1].

Note: Bloomberg ranked countries based on the efficiency of their health-care systems. Each country was ranked on three criteria: life expectancy (weighted 60%), relative per capita cost of health care (30%); and absolute per capita cost of health care (10%). Within each criterion, 80% of the score was derived from the most recent health-care system assessment and 20% to changes, if any, over the previous year.

In the airport shuttle taking us to our hotel in Mumbai, I looked out the window and thought, “We’re not in South Dakota anymore.” It was midnight and the streets of India’s largest city seemed as full of people, vendors, and traffic as Time Square at noon.

I had no real comparison, though, for the garbage strewn about, the beggars going from car to car when traffic stopped, the people sleeping on the sidewalks, the ramshackle condition of most buildings, and the roaming packs of stray dogs. The third poorest county in the US is just 60 miles from my home. It’s no match whatsoever for the real ghettos of Mumbai, where 55% of their population of 16 million live.

Given these great dissimilarities in economic status as well as political, religious, and cultural views, I expected to find striking differences between the Indian and U.S. financial advisor communities and their clients. Here is where I was surprised.

I traveled to Mumbai as a consultant to meet with a group of Indian financial advisors. After spending several days observing and listening to their struggles, I concluded 95% of the obstacles they face in promulgating client-centered, fiduciary planning are the same as planners see here in the US.

The most frequent complaint I heard was that consumers just won’t pay fees. They would rather pay a high commission they don’t see rather than a low fee they painfully do see. I find the same behavior in US consumers. It seems irrational, but it makes perfect sense when we understand the delusional money script of avoidance that says “If I don’t see the fee, then I must not pay a fee.”

Just as in the US, Indian advisors struggle to help consumers understand the math behind hidden commissions and visible fees. While most advisors can quickly calculate the amounts, consumers still find it hard to accept the numbers. There is great resistance to writing a check, even when a planning fee is half as much as an unseen fee or commission.. In my experience, most consumers have great difficulty emotionally understanding that writing a check for $10,000 for advisory fees on $1 million represents a $15,000 savings on a 2.5% wrap fee they don’t see and for which no check is written.

Another similarity is that those most willing to pay fees for service are the wealthier clients. I find this, too. At first blush one might surmise that of course the wealthy are more open to paying fees because they have more money. That isn’t the case. The fees paid are roughly proportionate. In fact, usually smaller accounts that go fee-only save proportionally more than do larger ones. The difference is that affluent or wealthy clients tend to be business owners or professionals who are familiar with employing fee-for-service consultants, like accountants and attorneys.

The transition to introducing fees is slow, requiring a lot of education on the part of the advisor and willingness to listen by the consumer. Similar to where the US was in the 80’s, India has only a handful of pioneering fee-only planners. Most advisors wanting to switch from pushing financial products to doing comprehensive financial planning have rolled out a fee-based model first. They hope consumers will eventually embrace the advantages—lower costs and lesser conflicts of interest—inherent in a fee-only compensation model.

I did find one significant difference from the US. In India, financial regulators are actively encouraging advisors to change from charging only commissions to charging fees. This support for a fiduciary standard may well help comprehensive financial planning become a strong profession.

I’ve been to Finland several times to study its culture and healthcare system.
With a world-class startup scene, highly educated people/workforce, and a unique and proven ecosystem that fosters R&D, Finland is one the best places to find new ideas and expand your business.